Obstetric History Versus Biomarkers: Hypertension Risk Up to 15 Years Postpartum

sFlt-1 (serum soluble fms-like tyrosine kinase-1) to PlGF (placental growth factor) can be used to predict the development of severe preeclampsia. The association between sFlt-1/PlGF during pregnancy and long-term risk of hypertension is unclear.

This is a retrospective cohort study of patients enrolled from 2006 to 2008 in the ongoing LIFECODES biobank. Mean sFlt-1 and PlGF levels were collected in the second half of pregnancy. Electronic medical record review identified those who developed hypertension over 15 year follow-up. Adjusted Cox proportional hazard models were used to estimate hazard ratios and 95% CI for the time to diagnosis of hypertension.

Of the n=993 participants, n=260 (29.18%) were diagnosed with stage 1 and n=169 (17.0%) were diagnosed with stage 2 hypertension. One hundred thirteen of the participants in the database had a diagnosis of gestational hypertension or preeclampsia. A history of preeclampsia or a history of gestational hypertension was both significantly associated with developing hypertension later in life, with adjusted hazard ratios of 2.17 (95% CI, 1.44-3.28) and 3.50 (95% CI, 2.21-5.54), respectively. We observed no significant association between the hazard of developing hypertension and sFlt-1/PlGF. However, mean PlGF levels in those who remained normotensive in the follow-up were significantly higher, 546.7 pg/mL (SD=369.5), compared with those who developed hypertension, 513.7 pg/mL (SD=389.9; P=0.008).

A history of hypertensive disease of pregnancy was significantly associated with the hazard of developing HTN later in life, while elevated sFlt-1/PlGF levels were not. PlGF levels alone were significantly lower in those who developed hypertension later.